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Pacifiers: Pacifier Use & Ideal Pacifier Shape

different pacifier shapes

Pacifiers have been around for a long, long time. Centuries ago, people used natural materials to make objects for their baby to soothe their baby. Early pacifiers were a combination of a rattle and a pacifier. Primitive pacifier rattles were made out of beads, sticks, coral, bone, shells, pods, or other natural materials.(1) The materials used had textures that would feel good on the baby’s gums during teething as well as smooth materials that felt good for satisfying their need to suck.

When ultrasounds are taken during pregnancy, you may have seen your baby mouthing and sucking on their hand. This early thumb sucking happens as early as 10 weeks old in utero but is thought to be more random until the sucking reflex begins around 32 weeks during pregnancy.(2) After birth, the rooting reflex, elicited when the cheeks are touched, helps the baby get ready to suck. When the roof of your baby’s mouth is touched by their thumb, your nipple, a bottle nipple, or a pacifier, the suck reflex is triggered and your baby begins to suck.

A pacifier can be a helpful tool but is not needed or necessary for every baby. Babies have a high need to suck. They get nutrients from sucking when they feed, but sucking also gives comfort, reduces discomfort, soothes, calms your baby, and helps them self-regulate. Putting your baby to your chest/breast every time they want to suck whether it be for calories or comfort is just fine. A pacifier can never take the place of being in your arms, against your body, and feeding at your chest. 

When a pacifier can be helpful

  • Car rides - it is best to plan lots of stops when taking a trip to be able to nurse your baby. A pacifier can be helpful to soothe your baby especially if they are trying to fall asleep while you’re driving in the car. Some babies have a hard time with short car rides as well. This can be a symptom of body tension or oral restrictions making being in the car seat uncomfortable. While you are addressing the root cause of their dislike of being in the car, a pacifier can help calm your baby when you do need to drive somewhere.
  • Soothing a baby with reflux - babies with reflux may seem like they always want to nurse. The act of sucking is soothing and drinking your milk can help relieve the pain from reflux, but can also cause more refluxing causing a vicious cycle. After you nurse your baby and know that they have had a full feeding, using a pacifier to allow your baby to continue to suck while you comfort them can be helpful. They should be in an upright or seated position rather than lying down while sucking on the pacifier.(3)
  • You need a break - being a new parent is a lot of work. You are likely feeling tired adjusting to being on a different schedule getting only snippets of sleep at a time. If your baby has been fed and still needs to suck, but you need a break, it is ok to use a pacifier as a tool and for short periods. 
  • When your baby is away from you - some families choose to use a pacifier for their baby when they are with a caregiver and not with you to nurse as often as they like for comfort. Always have the caregiver offer your pumped milk first in case your baby is hungry. If they are fed and still need comfort from sucking, a pacifier can be helpful while your caregiver also snuggles your little one.

Choosing a pacifier

  • It is recommended to wait until your baby is at least 4-6 weeks old before introducing a pacifier so it doesn’t interfere with establishing breastfeeding or your baby’s intake of breast milk. 
  • Choose a pacifier sized appropriately for the age of your baby. 
  • Choose a pacifier shape best suited for your baby or that has been recommended by your IBCLC
  • Most often a pacifier that is not very soft but has some resistance or rigidity to it is preferred. When the material is very soft, it can be easily compressed and your baby’s mouth will be in a closed rather than open position.
  • Consider a pacifier nipple shape that looks similar to how you would expect your nipple to look after your baby nurses.
  • Consider the material used to make the pacifier. All synthetic materials can have health implications so you may want to do further research to choose the one you are most comfortable with.
  • Choose a pacifier that is made from one piece to avoid the parts of the pacifier separating.

Pacifier shape

  • Cherry - may be round or flat near the base and is more rounded and bulbous near the tip
  • Orthopedic - these are more flat, wide-shaped nipples. They were made with the thought it would allow for more range of motion of the tongue to be used. It can inhibit the tongue from being able to cup the nipple.
  • Butterfly - the nipple is flatter in shape and the tip is flared or has a lipstick shape at the tip
  • Conical - this is typically the shape that is most often recommended for your baby. The nipple is long and straight and has the same diameter throughout except where it may widen close to the base. The material is typically more firm which allows your baby to put pressure against the nipple without it collapsing. The wider base encourages your baby’s lips to flange with an open mouth more similar to being at the chest/breast.

Risks with using a pacifier

  • Never use a string or other tether connecting the pacifier to your baby. It could pose a danger if it were to get wrapped around their neck.
  • Using a pacifier can delay feeding or skip a feeding altogether. Always offer your milk first before the pacifier. If your baby has low or slow weight gain, pacifier use may not be appropriate.
  • Using a pacifier regularly can interfere with your baby’s orofacial development. It promotes narrow jaw growth, a high palate, an open bite, and tongue thrust swallow.(5)
  • There is an increased risk of ear infections associated with pacifier use.(4)
  • Using a pacifier beyond 2 - 4 years old holds a higher risk of dental and oral growth complications.(5)

Breastfeeding is the original pacifier.(6) Keep in mind that your baby comes to your chest to meet a variety of needs and not just take in calories. It is always appropriate to offer to nurse your baby even after you just fed them. Nursing comforts your baby and meets their emotional needs, regulates their nervous system, breathing, temperature, and heart rate. If you decide to use a pacifier, be aware of the risks and choose the best pacifier for your baby’s needs. Use it as a tool and not a replacement for them to be at your breast/chest.(7)

Footnotes:

  1. https://www.encyclopedia.com/social-sciences-and-law/sociology-and-social-reform/sociology-general-terms-and-concepts/pacifier
  2. https://en.wikipedia.org/wiki/Thumb_sucking
  3. https://pubmed.ncbi.nlm.nih.gov/3412848/
  4. https://pubmed.ncbi.nlm.nih.gov/11979200/
  5. https://www.brianpalmerdds.com/bfeed_oralcavity.htm
  6. https://www.theatlantic.com/health/archive/2016/03/breastfeeding-pacifier-comfort-feeding/475836/ 
  7. http://www.nancymohrbacher.com/articles/2015/8/21/what-does-it-mean-to-use-your-breast-as-a-pacifier 

Other Resources:

https://books.google.com/books?id=jEIj1Zs7z3EC&pg=PA30&lpg=PA30&dq=dr+brian+palmer+mechanics+of+suck&source=bl&ots=Pl6IrquZEd&sig=ACfU3U0Ziu8tA_hliE_0TQTMm67vQCEBcg&hl=en&sa=X&ved=2ahUKEwiPmfHB99H0AhWUkIkEHfktDVwQ6AF6BAgCEAM#v=onepage&q=dr%20brian%20palmer%20mechanics%20of%20suck&f=false

https://www.aafp.org/afp/2009/0415/p681.html

https://www.breastfeedingbasics.com/qa/baby-uses-human-pacifier

https://www.diannecassidyconsulting.com/2021/05/30/help-my-baby-is-using-me-as-a-pacifier/

https://www.youtube.com/watch?v=ZD7Zh6wwltM

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1668-3


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